Contracts between participating providers and MCOs (HMOs and PPOs) typically include a "hold harmless" provision that protects enrollees from being balance billed by a network provider for covered services. In consenting to these provisions, participating providers generally agree not to seek reimbursement from an enrollee beyond payment of applicable cost-sharing requirements such as copayments, co-insurance or deductibles for services covered by the MCO.
In most states, "hold harmless" provisions are required by state law to be included in contracts between HMOs and participating providers. States may also require this type of language in contracts between providers and PPOs. To date, however, few have passed laws directly restricting out-of-network providers from balance billing MCO enrollees.
New Jersey HMOs and PPOs Yes Yes Yes, for emergency and urgent care services Yes Yes 【 在 aaddmm (adm) 的大作中提到: 】 : 你理解错了。这个说的是比如医院账单800，但contract rate是500，你和保险公司加 : 起来只付500，那300叫balance billing. 这500中，你自己付多少按照保险规定， : copay或coinsurance,或deductible. : 你因为是out of network, 所以估计没有contract rate. 剩余部分都是你的责任。你 : 仔细读读那个link里第三和四段的最后一句。
【 在 cllq (老虎下山) 的大作中提到: 】 : 你可能没有看仔细，在美国50个州里面有13个州有例出来不会付，包括新泽西州。 : Contracts between participating providers and MCOs (HMOs and PPOs) typically : include a "hold harmless" provision that protects enrollees from being : balance billed by a network provider for covered services. In consenting to : these provisions, participating providers generally agree not to seek : reimbursement from an enrollee beyond payment of applicable cost-sharing : requirements such as copayments, co-insurance or deductibles for services : covered by the MCO. : In most states, "hold harmless" provisions are required by state law to be : included in contracts between HMOs and participating providers. States may : ...................
tate Restriction Against Providers Balance Billing Managed Care Enrollees HMOs PPOs Location State Restriction Against Providers Balance Billing Managed Care Enrollees? Restriction Applies to HMO? Restriction Applies to Network Providers? Restriction Applies to Out-of-Network Providers? State Restriction Applies to PPOs? Restriction Applies to Network Providers? Restriction Applies to Out-of-Network Providers? United States 49+DC Yes 49+DC Yes 49+DC Yes 13 Yes 27 Yes 27 Yes 9 Yes Alabama HMOs only Yes Yes No No No No Alaska No No No No No No No Arizona HMOs only Yes Yes No No No No Arkansas HMOs only Yes Yes No No No No California HMOs and PPOs1 Yes Yes Yes, ER services (except ambulance services) Yes Yes Yes, ER services (except ambulance services) Colorado HMOs and PPOs Yes Yes No Yes Yes No Connecticut HMOs and PPOs2 Yes Yes Yes, for covered benefits Yes Yes Yes, for covered benefits Delaware HMOs only Yes Yes Yes, ER services and in certain other situations related to inadequate networks3 No No Yes, ER services and in certain situations related to inadequate networks District of Columbia HMOs only Yes Yes No No No No Florida HMOs and PPOs Yes Yes Yes, any other service covered and authorized by HMO and when the provider knows that the HMO is liable4 Yes Yes Yes, any other service covered and authorized by PPO and when the provider knows that the PPO is liable4 Georgia HMOs and PPOs Yes Yes No Yes Yes No Hawaii HMOs only5 Yes Yes No No No No Idaho HMOs and PPOs Yes Yes No Yes Yes No Illinois HMOs only6 Yes Yes Yes, ambulance services7 No No No Indiana HMOs only Yes Yes No No No No Iowa HMOs only Yes Yes No No No No Kansas HMOs only Yes Yes No No No No Kentucky HMOs and PPOs Yes Yes No Yes Yes No Louisiana HMOs only Yes Yes No No No No Maine HMOs and PPOs Yes Yes No Yes Yes No Maryland HMOs and PPOs8 Yes Yes Yes, for covered benefits Yes Yes Yes, for on-call physicians and hospital-based physicians that accept assignment of benefits Massachusetts HMOs and PPOs Yes Yes No Yes Yes No Michigan HMOs only Yes Yes No No No No Minnesota HMOs and PPOs Yes Yes Yes, for certain covered services9 Yes Yes Yes, for certain covered services9 Mississippi HMOs and PPOs Yes Yes No Yes Yes No Missouri HMOs only Yes Yes No No No No Montana HMOs and PPOs Yes Yes No Yes Yes No Nebraska HMOs and PPOs Yes Yes No Yes Yes No Nevada HMOs and PPOs Yes Yes No Yes Yes No New Hampshire HMOs and PPOs Yes Yes No Yes Yes No New Jersey HMOs and PPOs Yes Yes Yes, for emergency and urgent care services Yes Yes Yes, for emergency and urgent care services New Mexico HMOs and PPOs Yes Yes No Yes Yes No New York HMOs only Yes Yes Yes, for ambulance services and acute care facilities for end of life cancer care10 No No Yes for ambulance services10 North Carolina HMOs only Yes Yes No No No No North Dakota HMOs and PPOs Yes Yes No Yes Yes No Ohio HMOs only Yes Yes No No No No Oklahoma HMOs and PPOs Yes Yes No Yes Yes No Oregon HMOs and PPOs Yes Yes No Yes Yes No Pennsylvania HMOs and PPOs Yes Yes Yes, for emergency services Yes Yes Yes, for emergency services Rhode Island HMOs and PPOs11 Yes Yes Yes, for covered services provided or made available by an HMO Yes Yes No South Carolina HMOs only Yes Yes No No No No South Dakota HMOs and PPOs Yes Yes No Yes Yes No Tennessee HMOs only Yes Yes No No No No Texas HMOs and PPOs Yes Yes No Yes Yes No Utah HMOs only Yes Yes Yes, in rural areas for specified covered services No No No Vermont HMOs and PPOs Yes Yes No Yes Yes No Virginia HMOs only Yes Yes No No No No Washington HMOs and PPOs Yes Yes No Yes Yes No West Virginia HMOs only Yes12 Yes Yes, for covered services when a provider is aware that patient is an HMO enrollee No No No Wisconsin HMOs only Yes Yes No No No No Wyoming HMOs only Yes Yes No No No No 【 在 aaddmm (adm) 的大作中提到: 】 : 我看的非常仔细。如果你还那么自信，不付应付的cost sharing (coinsurance etc), : 你就等着creditj到600多吧。如果你无法理解下面这段话或我给你举的例子，你找同事 : 问吧，如果不怕被人笑的话 : typically : to
NJ, for emergency, even it's out of network, insurance companys/insurers are required to takes care of the difference, you should be treated as using in network service. 急诊不用考虑 in network or out of network（heart attack, traffic accident, etc, You just choose hospital close to your home without worrying about in network or out of network)
题外话：去年11月的关于非急诊的，about out of network的, 保护消费者的东东：http://www.nj.com/politics/index.ssf/2015/11/nj_assembly_panel_oks_bill_curbing_surprise_out-of.html
我去年7月份去医院看急诊，之后医生给我寄账单大约580元，因为医院的急诊医生不在保险公司网络，但是保险公司还是按州规定付了一部份220元左右。后来医生还是给我
寄账单，
并且把账单转给了追债公司，。
但是昨天我查信用发现追债公司把账单发到了信用局。这样我的信用从800分左右，降
到了700分，这样我买房子贷款就成了问题。
我打电话问了州政府，州政府说医生办公室不应当给我寄账单，在新泽西州是违法的，新泽西州法律规定，急诊病人不需要支付保险公司支付后的差额，并让我联系州的消费协会和医疗卫生局。现在我已经造成损失，我可以要求医生办公室赔偿吗？有诉讼的可能吗？
相关规定在这里：在美国有十三个州法律要求，如果我有保险，只要保险公司付了费用，医生就不能给我寄账单
http://kff.org/private-insurance/state-indicator/state-restriction-against-providers-balance-billing-managed-care-enrollees/
起来只付500，那300叫balance billing. 这500中，你自己付多少按照保险规定，
copay或coinsurance,或deductible.
你因为是out of network, 所以估计没有contract rate. 剩余部分都是你的责任。你
仔细读读那个link里第三和四段的最后一句。
【 在 cllq (老虎下山) 的大作中提到: 】
: 我去年7月份去医院看急诊，之后医生给我寄账单大约580元，因为医院的急诊医生不在
: 保险公司网络，但是保险公司还是按州规定付了一部份220元左右。后来医生还是给我
: 寄账单，
: 并且把账单转给了追债公司，。
: 但是昨天我查信用发现追债公司把账单发到了信用局。这样我的信用从800分左右，降
: 到了700分，这样我买房子贷款就成了问题。
: 我打电话问了州政府，州政府说医生办公室不应当给我寄账单，在新泽西州是违法的，
: 新泽西州法律规定，急诊病人不需要支付保险公司支付后的差额，并让我联系州的消费
: 协会和医疗卫生局。现在我已经造成损失，我可以要求医生办公室赔偿吗？有诉讼的可
: 能吗？
: ...................
Contracts between participating providers and MCOs (HMOs and PPOs) typically include a "hold harmless" provision that protects enrollees from being
balance billed by a network provider for covered services. In consenting to these provisions, participating providers generally agree not to seek
reimbursement from an enrollee beyond payment of applicable cost-sharing
requirements such as copayments, co-insurance or deductibles for services
covered by the MCO.
In most states, "hold harmless" provisions are required by state law to be
included in contracts between HMOs and participating providers. States may
also require this type of language in contracts between providers and PPOs. To date, however, few have passed laws directly restricting out-of-network
providers from balance billing MCO enrollees.
New Jersey HMOs and PPOs Yes Yes Yes, for emergency and urgent care services Yes Yes
【 在 aaddmm (adm) 的大作中提到: 】
: 你理解错了。这个说的是比如医院账单800，但contract rate是500，你和保险公司加
: 起来只付500，那300叫balance billing. 这500中，你自己付多少按照保险规定，
: copay或coinsurance,或deductible.
: 你因为是out of network, 所以估计没有contract rate. 剩余部分都是你的责任。你
: 仔细读读那个link里第三和四段的最后一句。
【 在 cllq (老虎下山) 的大作中提到: 】
: 你可能没有看仔细，在美国50个州里面有13个州有例出来不会付，包括新泽西州。
: Contracts between participating providers and MCOs (HMOs and PPOs)
typically
: include a "hold harmless" provision that protects enrollees from being
: balance billed by a network provider for covered services. In consenting
to
: these provisions, participating providers generally agree not to seek
: reimbursement from an enrollee beyond payment of applicable cost-sharing
: requirements such as copayments, co-insurance or deductibles for services : covered by the MCO.
: In most states, "hold harmless" provisions are required by state law to be
: included in contracts between HMOs and participating providers. States may
: ...................
可以理解。也无可厚非。确实难懂。
【 在 cllq (老虎下山) 的大作中提到: 】
: 我去年7月份去医院看急诊，之后医生给我寄账单大约580元，因为医院的急诊医生不在
: 保险公司网络，但是保险公司还是按州规定付了一部份220元左右。后来医生还是给我
: 寄账单，
: 并且把账单转给了追债公司，。
: 但是昨天我查信用发现追债公司把账单发到了信用局。这样我的信用从800分左右，降
: 到了700分，这样我买房子贷款就成了问题。
: 我打电话问了州政府，州政府说医生办公室不应当给我寄账单，在新泽西州是违法的，
: 新泽西州法律规定，急诊病人不需要支付保险公司支付后的差额，并让我联系州的消费
: 协会和医疗卫生局。现在我已经造成损失，我可以要求医生办公室赔偿吗？有诉讼的可
: 能吗？
: ...................
的保险公司需要按照in-network给报，不是按out-network报。这种错误，是保险公司
经常出的错误。你需要找保险公司appeal，不知道怎么appeal,可以给保险公司打电话
，他们会告诉你如何做。如果不放心，可以找health-advocate,许多公司的benefit里
面包括health advocate service,可以把你的case交给他们处理，free of charge。
你不应该把医生的账单置之不理，这样转到collect agency,就会损害你的信用。现在
第一要做的是找你的保险公司说明情况。
只能按innetwork的医生收费。
你仔细看一下条文上面列出的每个州的特例。
【 在 aaddmm (adm) 的大作中提到: 】
: 我看的非常仔细。如果你还那么自信，不付应付的cost sharing (coinsurance etc),
: 你就等着creditj到600多吧。如果你无法理解下面这段话或我给你举的例子，你找同事
: 问吧，如果不怕被人笑的话
: typically
: to
tate Restriction Against Providers Balance Billing Managed Care Enrollees
HMOs PPOs
Location State Restriction Against Providers Balance Billing Managed Care Enrollees? Restriction Applies to HMO? Restriction Applies to Network Providers? Restriction Applies to Out-of-Network Providers? State
Restriction Applies to PPOs? Restriction Applies to Network Providers? Restriction Applies to Out-of-Network Providers?
United States 49+DC Yes 49+DC Yes 49+DC Yes 13 Yes 27 Yes 27 Yes 9 Yes
Alabama HMOs only Yes Yes No No No No
Alaska No No No No No No No
Arizona HMOs only Yes Yes No No No No
Arkansas HMOs only Yes Yes No No No No
California HMOs and PPOs1 Yes Yes Yes, ER services (except
ambulance services) Yes Yes Yes, ER services (except ambulance
services)
Colorado HMOs and PPOs Yes Yes No Yes Yes No
Connecticut HMOs and PPOs2 Yes Yes Yes, for covered benefits Yes Yes Yes, for covered benefits
Delaware HMOs only Yes Yes Yes, ER services and in certain other situations related to inadequate networks3 No No Yes, ER services and in certain situations related to inadequate networks
District of Columbia HMOs only Yes Yes No No No No
Florida HMOs and PPOs Yes Yes Yes, any other service covered and authorized by HMO and when the provider knows that the HMO is liable4
Yes Yes Yes, any other service covered and authorized by PPO and when the provider knows that the PPO is liable4
Georgia HMOs and PPOs Yes Yes No Yes Yes No
Hawaii HMOs only5 Yes Yes No No No No
Idaho HMOs and PPOs Yes Yes No Yes Yes No
Illinois HMOs only6 Yes Yes Yes, ambulance services7 No No
No
Indiana HMOs only Yes Yes No No No No
Iowa HMOs only Yes Yes No No No No
Kansas HMOs only Yes Yes No No No No
Kentucky HMOs and PPOs Yes Yes No Yes Yes No
Louisiana HMOs only Yes Yes No No No No
Maine HMOs and PPOs Yes Yes No Yes Yes No
Maryland HMOs and PPOs8 Yes Yes Yes, for covered benefits Yes
Yes Yes, for on-call physicians and hospital-based physicians that
accept assignment of benefits
Massachusetts HMOs and PPOs Yes Yes No Yes Yes No
Michigan HMOs only Yes Yes No No No No
Minnesota HMOs and PPOs Yes Yes Yes, for certain covered
services9 Yes Yes Yes, for certain covered services9
Mississippi HMOs and PPOs Yes Yes No Yes Yes No
Missouri HMOs only Yes Yes No No No No
Montana HMOs and PPOs Yes Yes No Yes Yes No
Nebraska HMOs and PPOs Yes Yes No Yes Yes No
Nevada HMOs and PPOs Yes Yes No Yes Yes No
New Hampshire HMOs and PPOs Yes Yes No Yes Yes No
New Jersey HMOs and PPOs Yes Yes Yes, for emergency and urgent
care services Yes Yes Yes, for emergency and urgent care services
New Mexico HMOs and PPOs Yes Yes No Yes Yes No
New York HMOs only Yes Yes Yes, for ambulance services and acute care facilities for end of life cancer care10 No No Yes for
ambulance services10
North Carolina HMOs only Yes Yes No No No No
North Dakota HMOs and PPOs Yes Yes No Yes Yes No
Ohio HMOs only Yes Yes No No No No
Oklahoma HMOs and PPOs Yes Yes No Yes Yes No
Oregon HMOs and PPOs Yes Yes No Yes Yes No
Pennsylvania HMOs and PPOs Yes Yes Yes, for emergency services Yes Yes Yes, for emergency services
Rhode Island HMOs and PPOs11 Yes Yes Yes, for covered services
provided or made available by an HMO Yes Yes No
South Carolina HMOs only Yes Yes No No No No
South Dakota HMOs and PPOs Yes Yes No Yes Yes No
Tennessee HMOs only Yes Yes No No No No
Texas HMOs and PPOs Yes Yes No Yes Yes No
Utah HMOs only Yes Yes Yes, in rural areas for specified covered services No No No
Vermont HMOs and PPOs Yes Yes No Yes Yes No
Virginia HMOs only Yes Yes No No No No
Washington HMOs and PPOs Yes Yes No Yes Yes No
West Virginia HMOs only Yes12 Yes Yes, for covered services when a provider is aware that patient is an HMO enrollee No No No
Wisconsin HMOs only Yes Yes No No No No
Wyoming HMOs only Yes Yes No No No No
【 在 aaddmm (adm) 的大作中提到: 】
: 我看的非常仔细。如果你还那么自信，不付应付的cost sharing (coinsurance etc),
: 你就等着creditj到600多吧。如果你无法理解下面这段话或我给你举的例子，你找同事
: 问吧，如果不怕被人笑的话
: typically
: to
我这是最后一次回你这个帖子了。绝大多数保险，哪怕是 in-network, 你除了付
deductible（如果当年还没付满）, 还有co-insurance。你看看保险公司的EOB怎么说
的。如果你是属于绝少数，保险什么都cover的，当我没说，问你的保险公司为什么不
给你全付了。我不认为急诊200够，哪怕是in network。
我这是最后一次回你这个帖子了。绝大多数保险，哪怕是 in-network, 你除了付
deductible（如果当年还没付满）, 还有co-insurance。你看看保险公司的EOB怎么说
的。如果你是属于绝少数，保险什么都cover的，当我没说，问你的保险公司为什么不
给你全付了。我不认为急诊200够，哪怕是in network。
费用，因为虽然医生不在innetwork,但是急诊室是在in network,新泽西的法律规定急
诊的账单只能由保险公司和医生间协商，而不是在于病人，美国只有十三州有这个规定。我在网站看到一篇报道说是因为不知道这个规定，有50%的人看到账单就付了，大约
每年全美有1亿美元左右是多付给医生，发这个账单是提醒大家，需要这样的账单，可
以打电话给州政府或者bbb.
急诊不用考虑 in network or out of network（heart attack, traffic accident,
etc, You just choose hospital close to your home without worrying about in network or out of network)
题外话：去年11月的关于非急诊的，about out of network的, 保护消费者的东东：http://www.nj.com/politics/index.ssf/2015/11/nj_assembly_panel_oks_bill_curbing_surprise_out-of.html
的人，议价都是保险和医院医生的事情，我们都是等着价钱出来了，根据保险的copay,coinsurance来付
。out of network在有些州规定有些情况下也不能balance billing，新泽西的急诊就是这种情况。所以现在楼主的&#
24080;单是不是balance billing，是的话是医生的问&#
39064;;。如果是copay，coinsurance，deductible那就是楼主的问&#
39064;。
是正常的copay, coinsurance, 还是balance billing. 但是从楼主对账单置之不理来
看，她自己那部分肯定是没付清，除非她的保险是非常好的没有copay, coinsurance的。
我有一次in-network的pediatrician balance bill 55刀，因为保险不付，我就告诉医生保险EOB显示我不用付，医生办公室就去掉那账单。
这楼主一开始说的是要投诉或告医生办公室，现在可能意识到自己有问题了，开始说是好心提醒大家。不知她为何不去看看自己的EOB。
亿左右，所以在这里可以提醒一下新泽西的居民，如果急诊有医生账单，应当去参照一下最近州的规定。
另外：如果着急恢复credit score是为了买房拿到低利率，各个银行处理不同， 即使
他们声称目前的最低利率要求760, 780, 依然有好几个NJ的贷款经济人可以在你的贷款申请中加标注，加解释why your current credit score 低，帮助你拿到低利率。
的deductible，所以我付190，保险公司付190。但是我再打去消防局，消防局坚持我要付1800。我到底该付1800还是380？
（这800是保险公司和病人共同负担，按照in-network的EOB)，但是大夫不能额外的向
病人要那个200的差价（就是所谓的balance billing）。因为这时候急诊的大夫一律被当作
是in-network的。
State Restriction Against Providers Balance Billing Managed Care Enrollees
【 在 cllq (老虎下山) 的大作中提到: 】
: 对。
: 我的理解也是这样，这个楼主从头到尾都没有说清楚议价是多少，保险应付多少，自付
: 应该多少，这个看一下保险公司的EOB就一目了然了。她先要搞清楚医生发的那张账单
: 是正常的copay, coinsurance, 还是balance billing. 但是从楼主对账单置之不理来
: 看，她自己那部分肯定是没付清，除非她的保险是非常好的没有copay, coinsurance的。
: 我有一次in-network的pediatrician balance bill 55刀，因为保险不付，我就告诉医
: 生保险EOB显示我不用付，医生办公室就去掉那账单。
: 这楼主一开始说的是要投诉或告医生办公室，现在可能意识到自己有问题了，开始说是
: 好心提醒大家。不知她为何不去看看自己的EOB。
你这种货色就是天天给无良收费张目，LZ打你耳光啪啪响
好奇你是如何随时查到信用分数的?
【 在 cllq (老虎下山) 的大作中提到: 】
: update:信用报告已经增加了近50分。
: 我去年7月份去医院看急诊，之后医生给我寄账单大约580元，因为医院的急诊医生不在
: 保险公司网络，但是保险公司还是按州规定付了一部份220元左右。后来医生还是给我
: 寄账单，
: 并且把账单转给了追债公司，。
: 但是昨天我查信用发现追债公司把账单发到了信用局。这样我的信用从800分左右，降
: 到了700分，这样我买房子贷款就成了问题。
: 我打电话问了州政府，州政府说医生办公室不应当给我寄账单，在新泽西州是违法的，
: 新泽西州法律规定，急诊病人不需要支付保险公司支付后的差额，并让我联系州的消费
: 协会和医疗卫生局。现在我已经造成损失，我可以要求医生办公室赔偿吗？有诉讼的可
: ...................
呵呵，理都不理它。CREDIT SCORE没影响
【 在 capry (IA) 的大作中提到: 】
: well done!
: 好奇你是如何随时查到信用分数的?
谢谢
【 在 cllq (老虎下山) 的大作中提到: 】
: 化了钱的
【 在 cllq (老虎下山) 的大作中提到: 】
: update:信用报告已经增加了近50分。
: 我去年7月份去医院看急诊，之后医生给我寄账单大约580元，因为医院的急诊医生不在
: 保险公司网络，但是保险公司还是按州规定付了一部份220元左右。后来医生还是给我
: 寄账单，
: 并且把账单转给了追债公司，。
: 但是昨天我查信用发现追债公司把账单发到了信用局。这样我的信用从800分左右，降
: 到了700分，这样我买房子贷款就成了问题。
: 我打电话问了州政府，州政府说医生办公室不应当给我寄账单，在新泽西州是违法的，
: 新泽西州法律规定，急诊病人不需要支付保险公司支付后的差额，并让我联系州的消费
: 协会和医疗卫生局。现在我已经造成损失，我可以要求医生办公室赔偿吗？有诉讼的可
: ...................
【 在 lnzsks (lnzsks) 的大作中提到: 】
: 多谢楼主 我家最近也遇到了同样的问题 能问一下给州政府的哪个部门打电话吗？消费
: 者协会那个是打电话还是在网上交啊？